Treatment Success with Tigecycline in Combination in a Critically Ill Brucellosis Patient: A Case Report

Abstract

Neurobrucellosis is serious complication of Brucella infections and treatment options are quite controversial. Due to high relapse rates and treatment failure observed with monotherapy, a combined therapy is applied. In combination therapy, recently promising results are reported when tigecycline is combined with other antibacterial agents. Besides in-vitro studies, human case reports,-predominantly for severe and life-threatening infections-support treatment success. In this study, we are presenting a case of neurobrucellosis, who recieved a combination therapy including tigecycline, ceftriaxone and rifampicin and totally recovered with no sequela. Our case had the signs and symptoms suspecting of neurobrucellosis, but remained underdiagnosed and cardio/pulmonary arrest had occurred. After resuscitation the patient was hospitalized in the intensive care unit (ICU). Diagnosis of brucellosis was based on clinical features, culture and serological tests of blood and cerebrospinal fluid (CSF) samples, neuroimaging and confirmed by molecular methods. Tigecycline was used by intravenous (IV) route in combination with ceftriaxone and rifampicin, as the patient was mechanicaly ventilated and oral intake was by nasogastric (NG) tube. Risk of vomiting which would prevent doxycycline efficiency led us to apply this combination, to eliminate the risk in this critically ill patient. After observing significant improvement, the treatment was replaced with the oral treatment of rifampicin and doxycycline and terminated in six months. In conclusion, tigecycline seems to be a potential treatment option for brucellosis in combination with other drugs, particularly for specific patient groups, and severe and life threatening conditions related with brucellosis, who have limited alternative treatment options.